Date: <Date>

Case Number: <Case Number>

clientFirstNameclientMI<client<LastName

<clientStreetAddressLine1>

<clientStreetAddressLine2>

clientCity>, <clientStateclientZip

RE: Notice about your eligibility for health coverage

Dear <clientFirstName>:

This letter is to let you know there was a system error with your kynect application. Some non-citizen applicants were determined eligible for Medicaid benefits when they did not meet the eligibility requirements.

If you need any help with this notice, please call kynect at 1-855-459-6328 to talk with someone who speaks your language. You can request Spanish by dialing “2”, and request an interpreter for another language by dialing “3”. Or, contact your insurance agent, kynector or authorized representative.

Your kynector or insurance agent is:

<Name>

<Phone Number>

Your Medicaid coverage is being stopped

The system error has now been corrected. Your Medicaid benefits will be discontinued effective September30, 2014.Thisaction is based upon kynect’sfinding that you donot meet the immigrant status to receive Medicaid benefits. This is per Medicaid administrative regulation 907 KAR 20:100. You do not have to pay back any coverage benefit you have received from Medicaid.

You are not eligible for payment assistance

You do not qualify for payment assistance through kynect because you told us that you do not intend to file a federal income tax return for the 2014 tax year. Individuals who do not file taxes are not eligible for payment assistance per federal regulations at 45 C.F.R. 155.305 and 26 C.F.R, 1.36B-2. If you plan to file taxes for the 2014 tax year, you can report that change online, by phone, or by contacting your agent or kynector.

You are eligible to purchase a health plan through kynect

Based on the information that we have, you qualifyto purchase a health insurance plan at full price through kynect.

For your health coverage to start on 10/1/14, you must choose a plan by 9/30/14

You can pick a health plan that best fits your needs:

  • Online by following these steps:

1. Log onto your kynect account at kynect.ky.gov.

2. Click “Plans and Programs”

3. Click “Add Plan”.

4. Shop and pick the best plan for you. Check whether the plans you are looking at have your current doctors or hospitals.

  • In-person or by phone by contacting an insurance agent or kynector near you
  • By calling kynect Customer Service at 1-855-4kynect (459-6328) TTY: 1-855-326-4654. Dial “2” to get help in Spanish. Dial “3” for help in other languages
  • In-person at your local Department for Community Based Services office

If you think we made a mistake

If you think we made a mistake or you do not agree with our decision, you can appeal. To get the appeal form, log on to www.kynect.ky.gov and submit an appeal request. Or, call 1-855-459-6328 to request an appeal.

An important note

If a member of your household has recently experienced an emergency medical condition, not related to an organ transplant, and the absence of medical attention could place the individual’s health at risk, that individual could possibly be eligible for Medicaid under the time limited Emergency Medicaid program. The Emergency Medicaid program also covers delivery and post-partum services for pregnantwomen. Eligibility determinations for this program are completed at the local Department for Community Based Services.

Thank you,

kynect

Questions? Go to kynect.ky.gov. Or call 1-855-4kynect (459-6328) TTY: 1-855-326-4654. You can call Monday – Friday, 8 am to 7 pm Eastern time. The call is free.